Let’s talk a little bit more in depth about how obesity affects surgical procedures.

In most serious, intensive surgeries, you’re probably going to be under anesthesia, right? And you’re probably going to have medications to take afterwards. Stuff like this filtered through the kidneys and liver.

Obese patients have much higher rates of renal hypertension, which affects the kidneys, and morbidly obese patients have a 90% likelihood of having abnormalities in their liver.

That all adds up to a really bad time, and drugs being filtered out of the system quicker and therefore not working as intended. And you really want your anesthesia to work right when people are cutting into you.

In addition to this, some weight-based drugs are affected by fatty tissue, and some are not, so this can cause problems in determining the proper dosage.

Obese patients are at a higher risk for deep-vein thrombosis – this is when a blood clot forms in a deep vein, like in the leg. Surgery is recognized as a risk factor for DVT, and so obese patients undergoing surgery are doubly at risk.

Finding veins in the patient is also made difficult – it’s the difference between finding the edge piece in a 1000 piece puzzle, vs finding it in a 100 piece puzzle.

It’s harder to monitor blood pressure in obese patients as well, as standard cuffs may not work due to there being too much fatty tissue between the blood vessel and the cuff.

When you’re performing surgery, you have to pull back the flesh and muscle to get to where you’re trying to operate on – the more you have to pull back, the more difficult this becomes.

This image shows how much more you’re having to work through when doing an operation on an obese person:



So no, it’s not a matter of doctors being bad at their job. Surgery by itself is a difficult and risk-laden process – adding obesity on top of that adds an uneccessary layer of additional risk and complexity.

Sources:

Palmer M, Schaffner F. Effect of weight reduction on hepatic abnormalities in overweight patients. Gastroenterology 1990; 99: 1408–13.

Albert S, Borovicka J, Thurnheer M, et al. Pre- and post-operative transaminase changes within the scope of gastric banding in morbid obesity. Schweiz Rundsch Med Prax 2001; 90: 1459–64.

Gholam PM, Kotler DP, Flancbaum LJ. Liver pathology in morbidly obese patients undergoing Roux-en-Y gastric bypass surgery. Obes Surg 2002; 12: 49–51.

Ramsey-Stewart G. Hepatic steatosis and morbid obesity. Obes Surg 1993; 3: 157–9.

Clain DJ, Lefkowitch JH. Fatty liver disease in morbid obesity. Gastroenterol Clin North Am 1987; 16: 239–52.

Marik P, Varon J. The obese patient in the ICU. Chest 1998; 113: 492–8.

Ribstein J, duCailar G, Mimran A. Combined renal effects of overweight and hypertension. Hypertension 1995; 26: 610–5.

Braekkan SK, Siegerink B, Lijfering WM, Hansen JB, Cannegieter SC, Rosendaal FR. Role of obesity in the etiology of deep vein thrombosis and pulmonary embolism: current epidemiological insights. Semin Thromb Hemost 2013

Allman-Farinelli MA. Obesity and venous thrombosis: a review. Semin Thromb Hemost 2011; 37:903-7.

Potatriots : "If you don't love America, why don't you leave it?!"

Everyone else: "Because I don't want to be victimized by its foreign policies."

Postulation: an educated society to vote out Republicans; replace fundamentalist evangelism with intellectualism, skepticism and advocates of science; and evolve capitalism to manufacture critical thinkers and exploit human potential, resulting in the transition of the two-party political machine to machine learning via artificial intelligence toward a resource-based global economy, ensuring the survival and longevity of the Earth’s ecosystem including but not limited to monitoring and mitigating natural disasters on Earth as well as cosmic debris from our enveloping space environment so that ultimately we and the biodiversity of life we share our existence with (and because of) may expand our knowledge of and human presence amongst the universe to truly live long and prosper.

"I'm not bitter." He says, bitterly, with a bitter expression on his face.

Why do I support raising minimum wage? Because whenever I hear "You just work retail", it's insulting. It's like saying " Truck drivers just drive around for a living " or "Computer technicians just play with computers", it ignores everything people do in their line if work.

You know what I have to do? I'm a tailor, marking your clothes so they can be fitted for that job interview. I'm a baby sitter, watching out for your kids while your busy shopping to make sure they don't fall down the escalator or eat a handful of pins. I'm a computer technician, jury rigging and problem solving to make sure the twenty-year-old computers can ring up your purchases because the multi-billion dollar company I work for won't fix our replace the broken systems. I'm a fashion critic, giving you advice on how to color match, what to wear, when to wear it, how to wear it, and how to accessorize, so that way you don't march into your new job interview wearing jeans and a juggalo T-shirt. I'm psychiatrist, listening to your problems as you rant about anything and everything and expecting my input. I'm a customer service representative, getting screamed at for problems someone else caused (or more often, YOU caused) and now I must assuage your rage to make your visit a pleasant one. I'm a stocker, putting out the mountains of product we have, organizing it, sizing it, hanging it nicely, to make everything look great so you can barge through it, fuck everything up, and leave everything a mess before you leave. I'm a checker, needing to know what everything is priced, how everything is discounted, what to order, and all the steps needed to complete your purchase.

But rather then seeing us as people in a professional setting trying to make a living and running a business, you just see nameless faces doing grunt work. And so we have to smile at you, even though you're returning fifteen items, with no tags or receipts and you paid in cash, and you're infuriated that we're having difficulty completing your return. We have to smile at you, even though you have fifty items and twenty coupons, and there is a line, but you want to do sixteen transactions. We need to be polite and helpful, even though you came in the doors ten minutes before close and are here twenty minutes after we were supposed to have locked up. I nod and tell you "It's fine" when you say you need help carrying your twenty bags to your car, which you happen to have parked on the other side of the lot. I have to apologize on behalf of the company and listen to your sneering because you can't find one item on a sale day and we didn't carry that one item in the store normally for the nationally published catalog that got sent. We need to give you impeccable service, every time, while you are rude, belligerent, and obnoxious.

I have been insulted, threatened, and screamed at by customers. I have been burned, crushed, and stabbed on this job. I have metrics to meet, clients to appease, sales goals to reach, and bosses to make happy. I'm on my feet all day, I lift, have to think fast, be creative, be well-spoken and charming, and offer you service that will entice you to come back. I have to build displays while massively understaffed. I need to listen to customers telling me that I'm an idiot because their card was declined, because they are positive they paid the card off so it must be my fault. I'm given attitude because your coupon doesn't work, even though it says quite plainly that everything you picked up won't work with the coupon.

You want to know why I support raising the minimum wage? Because assholes like you make me DESERVE it. I bust my ass, every day, all day, and the last that could be expected is a wage that I can live on. So fuck you, you uppity cunt.

People have been using this



As their justification that 'Universal healthcare is bad', and that having it in the U.S. is a bad idea, that private healthcare is the answer to all of our problems because universal healthcare means you'll get shitty service for free.

Claims that private healthcare offers a better service are unsubstantiated. Let us have a cheeky look at the countries with the highest life expectancies in the world, and see what they have in common.



If you take a careful look at the 40 nations with the highest life expectancies you’ll see that the United States falls short of its other first world rivals. Now it seems odd that the only country here with a full private system that allows competition and rivalry scores lower than the socialised system we use so happily in the UK. (http://www.pacifichealthsummit.org/downloads/UHC/the%20political%20economy%20of%20uhc.PDF)

‘But the US has better quality of healthcare than those freedom hating commi-’



Hold up, buddy, what’s this long list that you’re currently clogging my dashboard with? That sure is rude of you. Well, let me tell you right now that this list shows the quality of care provided by each country. If you refer your eyeballs to the graph above, you’ll see the providers of the best care are for the most, part universal, with the US scoring again and again below the UK. It seems odd that whilst you claim private care is simply better, that it could score below out vastly superior public system.
(http://thepatientfactor.com/canadian-health-care-information/world-health-organizations-ranking-of-the-worlds-health-systems/)

A report produced by the Commonwealth Fund described the NHS as the best healthcare system in the world (http://www.commonwealthfund.org/publications/fund-reports/2014/jun/mirror-mirror), scoring highest on quality, access and efficiency. It is also the second-cheapest of the healthcare systems analysed. Not surprisingly, the private US system ranked last on indicators of efficiency, equity, and cost.

Now of course there’s waiting times, there’s denying in the UK and most other countries with universal healthcare we have waiting times. Do you know why this is? Do you think it’s because the government is failing to provide enough service? Or maybe or doctor are just lazy? No, we have longer waiting times because the number of people using our hospitals isn’t constrained to the privileged few who can afford it. Everyone here can afford healthcare because we don’t have to pay for it, it comes from our taxes. We don’t even have to think about the cost of healthcare. In the US less people see doctors because less people can afford them. This also explains why your life expectancy is a few years behind other first world nations. That being said the US doesn’t necessarily have shorter waiting times in all situations. A 2013 study discovered that British patients have better access to next day appointments, and also more American adults waited more than 6 days for primary care than British ones. However you know what the NHS does when you can’t get an appointment? It buys you one from a private provider anyway, so you’re not left without care. (http://www.theguardian.com/society/2015/aug/25/gp-appointment-waiting-times-in-us-worse-than-nhs)

What you also seem to forget is that the majority of countries with universal healthcare also offer completely private alternatives. If somebody has waiting times that could kill them, they could simply use a private provider… unless they can’t afford to, which they wouldn’t be able to anyway regardless of whether a private or public system is in place. Nobody is suggesting abolishing the private system, both public and private systems can exist together.
(http://www.ons.gov.uk/ons/rel/psa/expenditure-on-healthcare-in-the-uk/2013/index.html)

The competition by US health providers has not brought down costs, and in fact Americans pay a massive premium over British people (http://www.commonwealthfund.org/~/media/files/publications/in-the-literature/2013/nov/pdf_schoen_2013_ihp_survey_chartpack_final.pdfs). American healthcare is less cost effective both for the nation as a whole and for each individual who has to pay unfair insurance costs to have full coverage.

I will face god and walk backwards into hell.

The basis of every attempt to undermine the freedom of speech is always the charge that certain words and ideas are too dangerous to permit (read “oppressive” for today’s politics).  The political pretext for the targeting of every victim is that they are in fact the victimizer. Every act of suppression becomes an act of protection. Last of all, the thinking is always that because my reasons for abridging free speech are justifiable, they are not the same as attempts by others to violate it; in fact they are not a violation at all.

How do we distinguish between the exerciser and the violator of rights? The basic premise is simple. The only “injury” that requires the constraining of human conduct is that which restricts the liberty of another. Any other form of “injury” is solely the responsibility of the one who chooses to receive it. Do the words in question slander or libel? If they truly do so, then they rob a man of his freedom. He may not go about his life indifferent to these words even if he desires to, because they will effect his life regardless of his indifference. They genuinely infringe upon his liberty. On the hand, if someone is “injured” by words which another man or woman with a different emotional disposition could simply ignore, without suffering any subsequent loss of liberty, then there is no genuine violation here. All such speech is a legitimate exercise of liberty, and it is the suppression of it which violates the rights of the individual.